Antimicrobial sensitivity of Neisseria gonorrhoeae: a hospital-based study from Kuwait.
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Anti-Bacterial Agents↗
Biomedical subjects
A K Sharma
Publications and source records attributed to A K Sharma.
Improving patient and carer communication, multidisciplinary team working and goal-setting in stroke rehabilitation.
OBJECTIVE: To determine the extent to which three forms of multidisciplinary team (MDT) care in stroke rehabilitation meet the standards set by the United Kingdom National Service Framework (NSF). DESIGN: Consecutive assessment of the three forms of care was completed. SUBJECTS: The study included three groups of 25 stroke inpatients on the stroke rehabilitation ward. INTERVENTION: (1) A standard weekly MDT meeting using a standard form for documentation; (2) a standard MDT meeting using a newly devised form; and (3) a novel MDT ward round using the new form, and attended by doctors. RESULTS: MDT ward rounds result in significantly better consideration of patients' needs (median 7 per patient compared with 0 and 5 in phases one and two), enhanced SMART (specific, measurable, achievable, realistic and time framed) goal-setting (median 3 per patient compared to 1 in phases one and two); greater patient involvement (12 patients compared to 0 and 4 in phases one and two); and improved team working (measured using the team climate inventory) than do MDT meetings. CONCLUSIONS: In the present study, standard weekly MDT meetings did not meet the standards set for MDT care by the NSF. The use of a MDT ward round allows these standards to be achieved.
Aged↗
Recurrent hyperparathyroidism caused by parathyromatosis.
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Adenoma↗
Time dependent immunomodulatory response of exogenous melatonin to killed Pasteurella multocida (P52 strain) vaccine in albino rats.
The effect of time of administration of exogenous melatonin (M) at the rate of 100 microg/Kg BW of rat/day for 14 days on immunomodulation to killed Pasteurella multocida (P52 strain) vaccine (KPMV) was investigated in male albino rats during spring season with photoperiod of LL 13: DD 11 h and 25 +/- 2.5 degrees C air temperature and 70 +/- 4% relative humidity. The experiment was conducted at an altitude of 172 mts above mean sea level at latitude 28.20 degrees north, longitude 79.24 degrees east (Bareilly, U.P. India). The experimental animals were divided in-groups of 8 rats each, as KPMV + M at 4.00 h; KPMV + M at 16.00 h; KPMV and their controls M4, M16, PBS respectively. Humoral immune response was monitored at weekly intervals by an indirect ELISA and cellular immunity by leukocyte migration inhibition test (LMIT) and delayed type of hypersensitivity (DTH). As evinced by in-vitro assays and in-vivo protection studies, both humoral and cellular immune responses to KPMV were augmented in rats receiving exogenous melatonin at 4.00 h as compared to slightly reduced responses in rats treated with melatonin at 16.00 h. It was concluded that the circadian timings of melatonin administration modulate immune response in rats.
Adjuvants, Immunologic↗
Role of exercise tolerance test (ETT) and gated single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) in predicting severity of ischemia in patients with chest pain.
This was an observational study carried out in the department of cardiology. Bangabandhu Shikh Mujib Medical University (BSMMU), Dhaka in collaboration with Institute of Nuclear Medicine (INM), Shabag, Dhaka during the period October 2002-March 2003. A total of 54 patients presenting with Canadian Cardiovascular Society (CCS) class I-II severity of chest pain with mean +/-SD age 49.88 +/- 8.44 yrs and having male to female ratio 5.75:1 were included in the study. The main objective of the study was to predict severity of myocardial ischemia by Exercise Tolerance Test (ETT) determined by Duke Treadmill Score (DTS) and by perfusion pattern observed following Single-Photon Emission Computed Tomography myocardial perfusion imaging (SPECT-MPI). All patients underwent ETT and then SPECT-MPI scan using Tc-99m-tetrofosmin in one-day stress and rest protocol. Coronary angiogram (CAG) was done with in six months of the perfusion study. After performing ETT, patients were categorized by DTS and myocardial perfusion studies were also stratified according to severity of perfusion defect. The formula used to calculate the score was: Exercise time- (5 x ST segment deviation)-(4 X Treadmill angina index). The angiographic findings (significant >50% stenosis) and perfusion defects in MPI were compared with the severity of DTS. There were 31 patients who had CAG proven (>50% luminal diameter narrowing) CAD and 23 patients free of CAD. After ETT patients were categorized by Duke Treadmill Score into high DTS 12 (22.22%) patients, intermediate DTS 20 (37.03%) patients low DTS 22 (40.74%) patients. In high DTS group 91.66% patients had perfusion defect, whereas in intermediate and low risk group it was 60% and 40.9% respectively. In high DTS group 91.66% of patients had angiographicaly proven CAD, 58.33% of them had triple vessel disease (TVD) while in intermediate and low risk groups angiographically proven CAD were 65% and 22.72% of whom TVD only in 15% & 0% respectively. The results of ETT using DTS score were satisfactorily correlated with SPECT-MPI scanning in high DTS subsets of patients only. It is therefore, suggested that patient of high risk DTS do not need for myocardial perfusion imaging study and should undergo CAG for further evaluation. But the intermediate and low risk groups were needed myocardial perfusion imaging study to guide for further evaluation.
Adult↗
Effect in rats of simultaneous prenatal exposure to ochratoxin A and aflatoxin B1. II. Histopathological features of teratological anomalies induced in fetuses.
The histopathological features of various abnormalities induced by different doses of ochratoxin A (OA), aflatoxin B1 (AFB1), and their combination in rat fetuses were studied. The pregnant Wistar rats were orally treated during 6-15 gestation days with different doses of OA (0.125, 0.25, 0.50, 0.75 mg/kg), AFB1 (0.125, 0.25, 0.50, 1.00 mg/kg), and their combination (0.125+0.125, 0.25+0.50, 0.50+0.25 mg/kg). The fetal sections passing through liver, kidney, brain, heart, and eyes were selected from the fetuses given visceral examination representing each litter. The selected sections were processed for paraffin embedding, stained with H and E, and examined by light microscopy. The histological examination of the fetal organs revealed that OA, AFB1, and their combination treatments caused variable changes in internal organs. In the case of OA, the incidence of pathological lesions liver, kidney, brain, and eye lesions was high, whereas in AFB1 treatment, liver, brain, kidney, and heart were affected. The incidence of heart lesions, especially valvular defects, increased in the combination groups. Bile duct proliferation/new bile duct formation, defective ossification of cranial bones, exposure of the brain to the exterior, hypoplasia of cerebellum, and retinal defects observed in OA treatment and spinal cord defects in addition to liver, kidney, and brain changes observed in AFB1 were less severe in the combination groups. The present study indicates that the occurrence of brain, kidney, and liver lesions in combination treatment was less than in either individual treatment suggesting antagonism of OA-induced teratogenic effects by AFB1. The indication of subtle lesions due to an interference with normal development and arrest of differentiation in various internal organs observed in the present study suggests that microscopic examination of the tissues can provide additional useful information to a developmental toxicity study.
Abnormalities, Drug-Induced↗
Effects of training and supervision on recurrence rate after inguinal hernia repair.
BACKGROUND: There is little information about the effects of operative experience and supervision of trainees on outcome in inguinal hernia surgery, one of the cornerstone operations of basic surgical training. METHODS: All primary inguinal hernia repairs carried out between 1994 and 2001 were registered prospectively in the Lothian Surgical Audit database. Subsequent problems that required re-referral were identified from this database. Patients who required reoperation for recurrence a median of 3 (range 1-7) years after surgery were identified. RESULTS: Some 4406 repairs, including 90 recurrences (2.0 per cent), were identified. Open mesh, open sutured and laparoscopic techniques were employed. Senior trainees (registrars and senior registrars) had similar recurrence rates to consultants; supervision did not affect outcome. Junior trainees (senior house officers) had similar recurrence rates to consultants as long as they were supervised by either a senior trainee or a consultant. Unsupervised junior trainees had unacceptably high recurrence rates (open mesh: relative risk (RR) 21.0 (95 per cent confidence interval (c.i.) 7.3 to 59.9), P < 0.001; open sutured: RR 16.5 (95 per cent c.i. 7.2 to 37.8), P < 0.001). CONCLUSION: Senior trainees may operate independently and supervise junior trainees, with recurrence rates equal to those of consultant surgeons. Junior trainees should be encouraged and given more practice in inguinal hernia repair with appropriate supervision.
Education, Medical, Graduate↗
Beneficial effects and mechanism of action of Momordica charantia juice in the treatment of streptozotocin-induced diabetes mellitus in rat.
This study investigated the beneficial effects and mechanism of action of the juice of Momordica charantia in streptozotocin (STZ)-induced diabetes mellitus in rats. Diabetes mellitus was associated with significant (p < 0.01) time course reductions in body weight, plasma insulin and the number of insulin positive cells per islet and significant (p < 0.01) time course elevation in blood glucose and osmolarity and systolic blood pressure compared to age-matched healthy controls. Oral intake of M. charantia juice by STZ-induced diabetic rats partially reversed all the diabetes-induced effects measured. Daily oral administration of M. charantia juice to STZ-induced diabetic rates significantly (p < 0.01) reduced the Na+- and K+-dependent absorptions of glucose by the brush border membrane vesicles of the jejunum compared to the responses obtained in STZ-induced diabetic rat. Either insulin (100 MM) or the fruit juice lyophilised extract (5 microg x ml(-1)) can stimulate 14C-D-glucose uptake in L6 myotubes. These effects were completely blocked by wortmannin, an inhibitor of phosphatidylinositol 3-kinase. High concentrations (10-200 microg x ml(-1)) of M. charantia juice extract inhibited 14C-D-glucose uptake in L6 myotubes compared to the control response. The effect of M. charantia treatment was also investigated on myelinated fibre abnormalities in the tibial nerve of STZ-induced diabetic and control rats. The results show that diabetes was associated with significant (p < 0.05) reduction in the mean cross-sectional myelinated nerve fibres, axonal area, myelin area and maximal fibre area compared to end controls. Treatment of STZ-induced diabetic rats with M. charantia juice normalised the structural abnormalities of peripheral nerves. The results indicate that M. charantia can exert marked beneficial effects in diabetic rats, and moreover, it can regulate glucose uptake into jejunum membrane brush border vesicles and stimulate glucose uptake into skeletal muscle cells similar to the response obtained with insulin.
Animals↗
Distribution of Entamoeba histolytica Gal/GalNAc lectin-specific antibody response in an endemic area.
To demonstrate the dynamics of specific antibody isotypes against Entamoeba histolytica Gal/GalNAc adhesin and its correlation, if any, with the development of immunity, we evaluated subjects suffering from a spectrum of amoebic infections ranging from amoebic liver abscess (ALA) to asymptomatic cyst passers. The quantitative analysis of antibody levels was done in the sera by enzyme-linked immunosorbent assay. Gal/GalNAc adhesin-specific immunoglobulin G (IgG) was higher in ALA (and their follow-ups) and intestinal amoebiasis cases as compared with asymptomatic cyst passers (P < 0.05). Among the isotypes of IgG, high levels of IgG1 (60% of the total IgG concentration), suggestive of T-helper 2-type response, was associated with ALA cases. Intestinal amoebiasis cases and cyst passers had high percentage of IgG1 and IgG4 antibodies as compared with per cent IgG2 and IgG3 (of the total IgG), whereas follow-up cases of ALA had predominantly IgG2 and IgG3 isotypes of antibodies. Gal/GalNAc lectin-specific IgM antibodies were maximum in cases of intestinal amoebiasis. ALA cases and their follow-ups had significantly lower levels of Gal/GalNAc-specific IgM levels as compared with cyst passers (P < 0.05). Gal/GalNAc adhesin-specific IgA antibodies were raised maximally in intestinal amoebic infection cases. ALA cases and their 3-month follow-ups had significantly higher concentrations of lectin-specific IgA (P < 0.05) as compared with the healthy subjects.
Animals↗
Falls and vestibular impairment.
Unexplained fall is one of the commonest presentations to the Accident and Emergency (A & E) department of a hospital. The objective of this study is to assess the proportion of patients with symptoms of vestibular impairment among those presenting to an A & E department with an unexplained fall. Out of the total 3139 patients (fallers) presenting to an A & E department in 6 months, 546 had no known cause for the fall. Of these, 428 (76%) completed the vestibular symptom scale questionnaire. The presence and severity of vestibular symptoms for the past 12 months were assessed. The results showed that 80% of these patients had symptoms of vestibular impairment. We conclude that a large proportion of unexplained fallers suffered from symptoms of vestibular impairment within the last year, which may be responsible for their imbalance and falls. Identifying this group of patients is important as their symptoms and the resultant postural instability can be ameliorated by vestibular rehabilitation exercises.
Accidental Falls↗
Maternal and neonatal pemphigoid gestationis.
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Adult↗
Romifidine-ketamine anaesthesia in atropine and triflupromazine pre-medicated buffalo calves.
The study was conducted on 10 buffalo calves with a weight of 98.5 +/- 3.9 kg and age 9.7 +/- 1.3 months. Ten trials of two treatments were carried out using a randomized block design. Atropine at the dose of 0.02 mg/kg bodyweight was administered in both the groups. The animals of group I received romifidine at the dose of 10 microg/kg i.v., 10 min after atropine administration, whereas, animals of group II received triflupromazine at the dose of 0.3 mg/kg i.m. and 10 min later romifidine at the dose of 10 microg/kg i.v. immediately followed by ketamine at the dose of 5 mg/kg i.v. The onset of action of romifidine in group I occurred within 2 min and the animals remained under mild sedation for 31 +/- 4.8 min. In group II, the triflupromazine-romifidine-ketamine combination induced anaesthesia for 14 +/- 2.3 min. Hypothermia, significant bradycardia and respiratory depression was noticed in both groups at different time intervals.
Adjuvants, Anesthesia↗
Pathological and immunohistochemical study of experimental peste des petits ruminants virus infection in goats.
Peste des petits ruminants (PPR) is an emerging, economically important viral disease of goats and sheep in the Indian subcontinent. In the present investigation, 15 hill goats were experimentally infected with 2 ml of 10% splenic suspension of a virulent isolate of PPR virus (PPR/Izatnagar/94) that had caused heavy mortality (>75%) in goats during 1994 outbreaks in northern India. More than 86% (13 of 15) animals died between 9 and 13 days post inoculation at the height of temperature or when temperatures were declining. Necropsy findings included congestion of gastrointestinal tract (GIT), nasal sinuses, consolidation of antero-ventral lobes of lungs, engorged spleen, and occasionally oedematous lymph nodes. Histopathological examination of major organs of GIT revealed degeneration and necrosis of labial mucosa, severe mucosal and submucosal congestion, degeneration and necrosis of intestinal epithelium and lymphoid cell depletion from Peyer's patches along with presence of syncytia at times. Lungs showed broncho-interstitial changes and presence of intracytoplasmic and intranuclear eosinophilic inclusions in alveolar macrophages and syncytial cells. These changes in lungs were frequently complicated with serofibrinous pneumonia (57%, eight of 14). Lymphocytolysis and occasional syncytia formation were evident in the lymphoid tissues. Immunohistochemical (IHC) findings included presence of PPR virus antigen in the labial, intestinal, and bronchiolar epithelial cells, pneumocytes, macrophages and syncytial cells in lungs, and lymphoid (intact and necrotic) and reticular cells in lymphoid organs. The findings of the study indicated the highly virulent nature of the PPR virus isolate (PPR/Izatnagar/94), causing 100% mortality and characteristic pathological changes in the target organs such as lungs, intestines and lymphoid tissues. The results of the IHC study suggested that indirect immunoperoxidase could be an alternative method in the absence of more sophisticated methods of laboratory diagnosis of PPR virus infection in goats.
Animals↗
Prevalence of low birth weight and its determinants in an urban resettlement area of Delhi.
Birth weight remains an important factor affecting infant and child mortality. Many factors influence the occurrence of low birth weight (LBW). The present study was conducted to study the prevalence and determinants of LBW in an urban resettlement area of Delhi. A baseline survey was done to enroll all pregnant women in the area. These women were followed up every month till outcome. The prevalence of LBW was 39.1%. Occurrence of LBW was related to age, parity, weight and height of the mother. In multiple logistic regression analysis, mother's weight and parity alone emerged as significant variables. On further analysis, on adjusting for age, parity and birth weight were associated for the 20-35-year age group only. Thus, prevalence of LBW remains high in the urban under privileged of Delhi; maternal age, parity and weight and height are important determinants. Increasing age of first birth to more than 20 years can minimize effect of primi parity.
Adult↗
Predicting spasticity after stroke in those surviving to 12 months.
OBJECTIVE: To measure muscle tone in a cohort of patients 12 months after stroke and develop a preliminary model, using data recorded routinely after stroke, to predict who will develop spasticity. DESIGN: A cohort study. SETTING: Initially hospitalized but subsequently community-dwelling stroke survivors in Liverpool, United Kingdom. SUBJECTS: One hundred and six consecutively presenting stroke patients surviving to 12 months. MAIN OUTCOME MEASURES: Spasticity measured at a range of joints using the Tone Assessment Scale. RESULTS: The Tone Assessment Scale revealed spasticity in 38 (36%) patients and more severe spasticity in 21 (20%) of the 106 patients. Logistic regression analysis revealed that lower day 7 Barthel Index score and early arm or leg weakness were significant predictors of abnormal muscle tone; and lower day 7 Barthel Index score, left-sided weakness and ever smoked to be significant predictors of more severe muscle tone. CONCLUSIONS: Using the models, it may be possible to predict whether or not spasticity will develop in patients 12 months after stroke. The utility of the models is aided by their use of predictor variables that are routinely collected as part of stroke care in hospital and which are easy to measure. The models need testing prospectively in a new cohort of patients in order to test their validity, reliability and utility and to determine if other data could improve their efficiency.
Aged↗
Inadvertent insertion of nasogastric tube into the brain.
An unusual case of a nasogastric (Ryle's) tube inserted in the brain in a patient having severe head injury with skull base fractures is reported here along with a brief review of literature. A 35 years male was referred from a peripheral institute following head trauma with endotracheal tube and nasogastric tube in situ. A CT scan of the brain showed multiple skull base fractures and a high parietal extradural hematoma. It also revealed that the nasogastric tube had inadvertently found its way into the brain through the lamina cribrosa of the ethmoid bone. The tube was removed under aseptic conditions in the operation theatre but the patient expired on day 2 of admission due to the head injuries sustained.
Adult↗
Prevalence and determinants of reproductive tract infections among women.
Reproductive tract infections (RTIs) are one of the most common health problems in women during reproductive age. There are gaps in the knowledge regarding the prevalence and determinants of these infections among women. A cross-sectional study was conducted at Primary Health Centre, Palam. Three hundred currently married women from antenatal and gynae clinic were interviewed followed by clinical examination and microbiological investigations. The prevalence of RTIs was 37.0 % based on symptoms and 36.7 % by laboratory investigations, including 26.3% candidiasis, 18.0% vaginitis, 15.7% trichomoniasis and 14.3% bacterial vaginosis. Factors which were found to be significantly associated with reproductive tract infections in women were not cleaning genitals daily, last delivery being domiciliary, history of anal intercourse, last delivery conducted by dai, relative/neighbour, not bathing daily, not bathing daily during menstruation and history of abortions. Strength of association of these factors was further analysed using the odd ratio with 95% confidence interval.
Adolescent↗
Studies on the immunogenic potential of plant-expressed cholera toxin B subunit.
Nicotiana tabacum var. Samsun was transformed via Agrobacterium-mediated transformation with a gene encoding the cholera toxin B subunit (CTB) of Vibrio cholerae, modified to contain a sequence coding for an endoplasmic reticulum retention signal (SEKDEL), under the control of the cauliflower mosaic virus 35S promoter. Total protein from the transgenic leaf tissue was isolated and an aliquot containing 5 microg recombinant CTB was injected intradermally into Balb/c (H2K(d)) mice. CTB-specific serum IgG was detected in animals that had been administered plant-expressed or native purified CTB. A T-cell proliferation study using splenocytes and cytokine estimations in supernatants generated by in vitro stimulation of macrophages isolated from the immuno-primed animals was carried out. Inhibition of proliferation of T lymphocytes was observed in splenic T lymphocytes isolated from animals injected with either native or plant-expressed CTB. Macrophages isolated from mice immunised with native or plant-expressed CTB showed enhanced secretion of interleukin-10 but secretion of lipopolysaccharide-induced interleukin-12 and tumor necrosis factor alpha was inhibited. These studies suggest that plant-expressed protein behaved like native CTB with regards to effects on T-cell proliferation and cytokine levels, indicating the suitability of plant expression systems for the production of bacterial antigens, which could be used as edible vaccine. The transgene was found to be inherited in the progeny and was expressed to yield a pentameric form of CTB as evident by its interaction with G(M1) ganglioside.
Animals↗